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Association of Pharmacologic Treatment of Urgency Urinary Incontinence With Sleep Quality and Daytime Sleepiness

Warsi Qurratul A. MBBS MAS; Huang, Alison J. MD, MAS; Hess, Rachel MD, MS; Arya, Lily A. MD; Richter, Holly E. PhD, MD; Bradley, Catherine S. MD, MSCE; Rogers, Rebecca G. MD; Myers, Deborah L. MD; Johnson, Karen C. MD, MPH; Winkelman, William D. MD; Gregory, W. Thomas MD; Kraus, Stephen R. MD; Schembri, Michael BS; Brown, Jeanette S. MD; Stone, Katie L. PhD; Subak, Leslee L. MD
doi: 10.1097/AOG.0000000000002443
Original Research: PDF Only

OBJECTIVE:

To evaluate the association between pharmacologic therapy for urgency urinary incontinence (UUI) and sleep quality.

METHODS:

We conducted a planned secondary data analysis of sleep outcomes in a previously conducted multicenter, double-blind, 12-week randomized trial of pharmacologic therapy for urgency-predominant incontinence among community-dwelling women self-diagnosed using the 3-Incontinence Questions questionnaire. Participants (N=645) were assigned randomly to 4–8 mg antimuscarinic therapy daily or placebo. At baseline and 12 weeks, participants completed a validated voiding diary to evaluate incontinence and voiding symptoms, the Pittsburgh Sleep Quality Index to evaluate sleep quality, and the Epworth Sleepiness Scale to evaluate daytime sleepiness.

RESULTS:

Mean (SD) age was 56 (±14) years, 68% were white, and 57% had poor sleep quality (Pittsburgh Sleep Quality Index score greater than 5). Mean frequency of any urinary incontinence and UUI was 4.6 and 3.9 episodes/d, respectively. After 12 weeks, women randomized to the antimuscarinic group reported greater decrease compared with the placebo group in UUI frequency (0.9 episodes/d; P<.001) and diurnal and nocturnal voiding frequency (P<.05). As compared with the placebo group, women in the antimuscarinic group also reported greater improvement in sleep quality (total Pittsburgh Sleep Quality Index score 0.48; P=.02) with greater improvement in sleep duration and sleep efficiency subscales (P<.05). The intervention did not affect daytime sleepiness.

CONCLUSION:

Pharmacologic treatment of UUI is associated with decreased incontinence frequency and nocturia and improvement in overall sleep quality, sleep duration, and sleep efficiency.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT00862745.

Corresponding author: Leslee L. Subak, MD, Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, HG332 Stanford, CA 94305-5317; email: LSUBAK@Stanford.edu.

Pfizer, Inc, provided funding for the study and the study medication but did not provide other input into the design of the study; collection, analysis, or interpretation of data; writing of the report; or the decision to submit the paper for publication. The Principal and Co-Principal Investigators, Drs. Brown and Huang, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Financial Disclosure Dr. Huang has received research grants from Pfizer, Inc and Astellas, Inc to conduct research related to urinary incontinence. Dr. Richter has received research grants from Astellas and educational grants from Warner Chilcott and has served as a consultant for Xanodyne Pharmaceuticals, Uromedica, Pfizer, Astellas, and IDEO. Dr. Rogers receives royalties from UpToDate, travel and stipend from the American Board of Obstetrics and Gynecology, and travel and stipend from the International Urogynecology Journal. Dr. Brown has received research grants from Pfizer, Inc and Mytrus, Inc to conduct research related to urinary incontinence. Dr. Subak has received research grants from Astellas, Inc and was additionally supported by grant 2K24DK080775-06 from the U.S. National Institutes of Health. The other authors did not report any potential conflicts of interest.

Presented at the American Urogynecologic Society Pelvic Floor Disorders Week 2016, September 27–October 1, 2016, Denver, Colorado.

The authors acknowledge the important contributions made by Bringing Simple Urge Incontinence Diagnosis and Treatment to Providers (BRIDGES) study investigators, staff, and data and safety monitor. For a list of institutions and participants, see Appendix 1, available online at http://links.lww.com/AOG/B53.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.